The present invention relates to a method and an apparatus for aiding the treatment of sleeping disorders that are aggravated by an insomniac""s underestimation of total sleep time and sleep efficiency and overestimation of time necessary to fall asleep.
Statistics indicate that sleeping disorders such as insomnia plague a significant percentage of the worlds population. People with insomnia in the United States alone number in the millions. Although there are several types or classifications of insomnia or similar sleeping disorders and a variety of possible causes, many theories suggest that insomniacs are generally either physiologically or cognitively hyperaroused relative to normal sleepers. In essence, many clinical tests and studies indicate that a substantial subset of people who suffer from insomnia unintentionally promote their condition by the anxiety resulting from their knowledge or misconception that they cannot readily fall asleep. It has been demonstrated that insomniacs generally underestimate their total sleep time and, more particularly, overestimate the amount of time necessary for them to fall asleep. As a result, the insomniac""s problem is perpetuated and causes the insomniac to feel tired the next day.
Common methods of treating insomnia involve the use of prescription drugs or sleep training exercises, or both. For many reasons, a successful sleep training method would be preferred over drug therapy. Thus, a method of sleep training that allows the insomniac to make accurate determinations of sleep onset and total sleep time could contribute to the successful reduction or cure of an individual""s insomnia.
Chronic insomnia is a distressing complaint that affects a significant percentage of the world""s population; 35 to 40 million in the United States alone. Chronic insomnia is believed to be a problem for 15 to 30 percent of the adult population and close to 65 percent for some special groups, such as shift workers and psychiatric patients. Prevalence rates are fairly similar among the countries where insomnia has been studied: England, Finland, Israel and Italy. The number of advertisements for hypnotic drugs in the scientific journals give some idea of the importance of this disorder as a medical problem.
Three general types of insomnia have been described: initial, or sleep onset; intermittent, or sleep maintenance; and terminal, or early morning awakening. Several studies suggest that insomniacs are either physiologically or cognitively hyperaroused relative to normal sleepers. Individuals who are highly aroused may experience difficulty in falling asleep or may awaken frequently at night because sleep is associated with low levels of autonomic arousal. Data from two separate studies support the hypothesis that physiological arousal or anxiety is an etiological factor in insomnia. Insomniacs also seem to be characterized by neuroticism, anxiety, or worry. The results of a complete evaluation of nearly 8000 patients in the Sleep Disorders Clinics (ASDC) across the United States support the conventional hypothesis that insomnia is caused by depression or stress. In essence, multiple clinical tests and studies indicate that many people who suffer from insomnia unintentionally promote their condition by anxiety resulting from their knowledge that they cannot readily fall asleep. A significant direct correlation has been found between the Manifest Anxiety Scale score and 1) time required to fall asleep, 2) number of times awake, 3) time required to go back to sleep and 4) report of sleep difficulties. Corresponding daytime complaints typically include fatigue, sleepiness, poor performance, aching muscles, anxiety and loss of concentration and memory. Chronic insomniacs are two and one-half times as likely as non-insomniacs to report vehicle accidents in which fatigue was a factor. One study presented evidence that the complaint of insomnia is an important mortality risk factor. Similarly, clinical experiences support two hypotheses: 1) poor sleep causes drowsiness, poor health and, hence, poor performance, or 2) the complaint of insomnia indicates a person with chronic psychological problems that extend beyond sleep.
Well over half of any large population of individuals who complain of insomnia are likely to be using one or more sedative drugs on a daily basis. Although only five percent of insomniacs actually have visited a health professional for their sleep problems, 28 percent use alcohol, 29 percent self-administer over-the-counter medications and 12 percent use both to try to get to sleep. The estimated cost for retail prescriptions of hypnotics in 1970 was $170 million and has increased significantly since that time. In 1991, for example, three sleeping pills, Halcion, Restoril, and Dalmane accounted for nearly 11 million prescriptions written.
Many hypnotic drugs are ineffective and may cause sleep alterations, especially if consumed in excessive doses over long periods. One study found that initially the following drugs: chloral hydrate, ethcloruznol, glutethimide, methaqualone, methaqualone HCl and secobarbital were moderately to markedly effective in inducing or maintaining sleep, or both. The study also found, however, that, at the end of a two week period of drug administration, a loss of effectiveness for sleep induction or maintenance, or both, had developed with all these drugs. It is at this danger point where patients begin to increase their dosage or use to try to maintain the same effect. Consequently, the widespread use of hypnotic medication has also made accidental overdosage in people using or abusing these drugs a substantial health hazard. Where drugs are correctly administered, withdrawal of rapidly eliminated benzodiazepine hypnotics can lead to a condition called rebound insomnia. With ultrashort half-life drugs, early morning insomnia, another withdrawal phenomenon, may occur even during administration.
Additionally, some of these drugs may have unwanted side effects. In 1990, when the Food and Drug Administration tallied the numbers of hostile acts reported in association with 329 different prescription drugs, Halcion ranked No. 1 followed by Xanax. Ideally, patients with disturbed sleep should be educated not only to the effectiveness and side effects of prescription drugs, but also to the adverse effects of stimulant pharmacologic agents: cigarette smoking, caffeinated beverages and alcohol.
The use of behavioral techniques in the treatment of insomnia is based on the premise that anxiety or heightened autonomic arousal is an etiological or maintaining factor. Behavioral methods have the additional benefits of the absence of adverse side effects and rebound effects associated with drug treatment. If heightened physiological arousal or anxiety inhibits sleep, reduction of anxiety or autonomic activity levels would logically facilitate sleep. In this regard, one of the more interested findings to come out of sleep research, is that insomniacs as a group significantly overestimate sleep latencies and underestimate total sleep and sleep efficiency. Overall assessment of sleep by the patient must depend partly on the patient""s own estimate of sleep duration, which in turn depends on how long the patient takes to fall asleep and how often and for how long the patient remains awake during the night. If the patient is inaccurate in assessing these factors, then the insufficiency of the patient""s sleep will, ipso facto, be exaggerated.
Following this line of reasoning, several studies suggest that relaxation, systemic desensitization, biofeedback, or other anxiety reducing procedures may be effective in the treatment of insomnia.
It is therefore an object of the invention to apply behavioral techniques to the treatment of insomnia by correcting an insomniac""s overestimation of sleep latency and underestimation of total sleep and sleep efficiency.
It is another object of the invention to provide a drug-free sleep training method for the insomniac to become aware of accurate determinations of sleep onset and, therefore, total sleep time.
It is yet another object of the invention to provide a sleep training method utilizing equipment that causes minimal discomfort or distraction.
It is a further object of the invention to provide a sleep training method that is self-administrable and does not require outside assistance or monitoring.
It is a still further object of the invention to provide a system for treatment of insomnia that makes the insomniac aware of his progress over time.
These and other objects of the invention are achieved by a system according to the invention that allows an insomniac to observe and record sleep onset, sleep latency, total sleep time and sleep efficiency. First, the insomniac initiates a measuring of time on a time measuring device, such as a watch, switchable by a hand actuator when the insomniac is placed in a condition to fall asleep. The user can additionally record that time. Next, when the insomniac transitions to a sleep condition, the measuring of time is halted by the equipment of the invention. When the insomniac awakens, the insomniac observes and can record the waking time.
A wake time interval can be calculated by reading the time elapsed on the time measuring device. This interval can be recorded and represents the time between being placed in a condition to fall asleep and actually falling asleep. A sleep time interval can also be calculated by subtracting the total time that the insomniac has spent trying to get to sleep from the time interval defined by the time between being placed in a condition to fall asleep and the insomniac""s final waking time.
Thus, the insomniac becomes aware of the real time he spent falling asleep after going to bed or the like and of the actual time he slept. This accurate determination and realization of initial wake time and actual sleep time assists the insomniac in overcoming his misconceptions of his sleeping behavior that perpetuates the insomnia.
The time measuring device used in the system of the invention should minimize discomfort or interference with the user""s sleep. The time measuring device can, for example, be secured on an insomniac""s wrist in the form of a watch which includes an internal means for initiating and halting the measuring of time connected to an external activating means for controlling the time initiation and halting means. Preferably, the external activating means will be in the form of two contacts, biased in an electrically separated position and secured to the thumb of the insomniac. Alternatively, the external activating means can be in the form of a contact secured to the thumb and a contact secured to an opposing finger of the insomniac. The contacts, when connected, activate the initiation means, for example, by connecting a watch battery electrically to the watch electronics. When separated, the contacts breaks the circuit and disrupt power to the watch electronics, thereby halting the advancing time. The resulting display or reading memorializes for the user the actual time the user spent falling asleep.
When the insomniac is placed in a position to fall asleep, the insomniac will actuate the external activating means by touching the two contacts together. When the insomniac falls asleep, the insomniac moves to a sleep condition in which the contacts are separated, and the activating means is then deactivated to halt time measuring at the sleep onset time.
Upon wakening, the insomniac can calculate the wake time interval by observing the time elapsed on the time measuring device. Because the insomniac has observed the time that the insomniac was placed in the position to fall asleep and the time that the insomniac awoke, the sleep time interval may be calculated by subtracting the wake time interval from the interval between the time that the insomniac was placed in the position to fall asleep and the time that the insomniac awoke.
The system of the invention allows the insomniac to determine exactly how much time passed between lying down or the like and the onset of sleep the night before. This value can be compared to the total time spent in bed to determine the percentage of wake time elapsed during each night. Recording the total wake time and the total time spent in bed over a period of successive nights allows an insomniac to realize his improvement over time. Such realization further reduces the anxiety that can contribute to the insomnia.
The wake time interval need not be limited to a single occurrence. The insomniac can touch the contacts together at the time of each waking occurrence throughout the night. The time measuring device can re-start time measuring, not from a xe2x80x9czeroxe2x80x9d time, but from the point that the device halted after the first onset of sleep. The device halts time measuring again at each subsequent onset of sleep. Accordingly, the total wake lapse time during a night can easily be calculated.
The inventive method can also be repeated for as many days as the insomniac desires, calculating daily wake time intervals, sleep time intervals and total sleep time intervals, and charting these intervals for each successive day. When the insomniac is informed of the change in each interval, the insomniac can measure sleep performance due to reduced anxiety.
Thus, the invention provides a self-administered method of sleep training that is supported by psychological principles and theories from two different fields of psychology: behavioral and paradoxical. Behavioral Psychology theories state that when a behavior is coupled or followed by an adversive stimulus, that behavior will decrease. In the system of the invention, the time an insomniac stays awake is coupled with the mildly adversive stimulus of maintaining contact between the two fingertips to improve treatment of insomnia. When the insomniac falls asleep, the adversive stimulus is removed with the separation of the fingers or other contact parts. Thus, application of stimulus response theories allow the method to reduce values for total wake time.
A theory of Paradoxical Psychology states that by pairing a second behavior which is incompatible with a first behavior one is trying to control, one gains conscious control over the originating behavior. Use of the system of the invention pairs the incompatible behavior of holding two fingertips together with the behavior of falling sleep to allow an insomniac to gain control over falling asleep. Where an insomniac has greater control over falling asleep, total sleep time increases.
Accurate recording of sleep onset, which is less than the insomniac""s estimate, should significantly reduce the time for sleep onset and allow the insomniac to return to sleep quicker if the insomniac awakens during the night or early morning.